Physiotherapy for Functional Neurological Disorders

Can physical therapy treat functional neurological disorders (FNDs)?

Physical therapy helps some people with a functional neurological disorder regain the ability to perform difficult movements and activities, such as walking, standing up, or using an arm. Treatment includes information about the disorder, strategies for focusing attention, and gradual practice. The effects vary depending on the symptoms and the measured outcomes.

A functional neurological disorder (FND) disrupts the functioning of brain networks involved, in particular, in movement and sensation. The symptoms are real and involuntary. They cannot be explained by a neurological lesion—damage to nerve tissue—that corresponds to the observed problem, but a FNT can coexist with another condition. Its diagnosis is based on specific signs observed during an examination, not merely on normal test results.¹ To understand the diagnosis, see our guide to functional neurological disorders.

A systematic review—that is, a study that compiles and evaluates research on a specific issue—identified fourteen clinical signs that had been studied. Their specificity ranged from 92 to 100 percent: in groups without functional impairment, these signs were absent in 92 to 100 percent of individuals. This figure does not indicate the probability of having a TNF when a sign is present. The ability of each sign to identify individuals with a TNF varied greatly, and the absence of a sign does not rule out this diagnosis.²

In the Physio4FMD trial, specialized physical therapy did not show clear superiority over standard neurological physical therapy in terms of self-reported physical function after 12 months. Participants in the specialized program reported improvements in their motor symptoms—those affecting movement—more frequently. Certain measures of mental health also favored this program.³ A previous feasibility study reported a perceived improvement at six months in 72% of the treatment group, compared with 18% of the group receiving standard care.⁴ The study randomly assigned 60 participants to the groups. After three dropouts, the analysis included 57 participants.⁴ A feasibility study first determines whether a protocol can be organized and accepted before a larger trial is conducted.

In Quebec, the University of Montreal Hospital Center (CHUM) offers a rehabilitation program that brings together professionals from various fields to help people with TNF resume their daily activities.⁵

What is specialized physiotherapy for FND and how does it differ from standard physiotherapy?

Compared to standard neurological physical therapy, specialized physical therapy for TNF places particular emphasis on attention and the practice of more automatic movements. Standard neurological physical therapy shares many of these objectives. Recommendations specific to TNF place particular emphasis on explaining the diagnosis, attention, and movement retraining.⁶ These recommendations are based on a consensus—that is, an agreement among clinicians who combine available studies with their own experience. They do not prove that each technique, taken separately, produces a lasting benefit.⁶

The physical therapist selects strategies based on the movements that are causing you difficulty. For example, the exercises may focus on moving from the bed to a chair rather than on an isolated knee movement. Fatigue, pain, balance, and your goals also guide the program.¹

After a stroke, a disruption in blood flow or bleeding can damage part of the brain. Rehabilitation may focus on walking, arm movements, and daily activities.⁷ Other conditions, such as multiple sclerosis—a disease that affects the protective covering of nerve fibers—or a spinal cord injury—the nerve cord that transmits messages between the brain and the body—also require an assessment of the affected functions.

In TNF, the brain networks involved in movement, sensation, and attention function differently. Another neurological disorder may be present at the same time; it requires its own treatment.¹ The model proposed by Edwards and his colleagues in 2012 describes how expectations, past experiences, and bodily sensations might influence perception and movement.⁸ This model explains certain observations, but it does not demonstrate the exact mechanism at work in each individual or a single psychological cause.

A functional problem may be real even when an examination does not reveal any lesion that explains the symptoms. The purpose of the diagnosis is to understand the observed signs and the prospects for recovery. Treatment then focuses on finding ways to make your movements easier; it does not involve replacing or reprogramming any part of the brain.⁹

How does the specialized approach compare to standard neurological physical therapy?

Specialized physical therapy for TNF may use conversation, a rhythm, or a specific activity to facilitate a difficult movement. For some people, focusing too intensely on the movement can disrupt it; diverting their attention can then be helpful. The physical therapist tries several different instructions and selects the ones that make the task easier.¹⁰

In Episode 59 of the “Parle-moi de santé” podcast, Pierre-Luc Lévesque, a physical therapist at the CHUM, describes how to use humor, play, and multitasking to divert attention away from difficult movements. The team also discusses fear of movement when it arises.¹¹

Intense voluntary effort can sometimes disrupt a functional movement. In a 2013 experiment, eleven people with functional motor symptoms and eleven people without TNF performed several tasks. The individuals with TNF performed less well on certain predictable tasks that allowed for movement planning. However, their automatic adaptation to a change in the relationship between vision and movement remained comparable to that of the control group.¹⁰ This small study does not allow for generalizing the results to all movements or all individuals. The term “functional” describes these disorders without automatically attributing a psychological cause to them.¹²

Standard neurological physical therapy includes strength training, gait training, and repetitive tasks. The program for TNF often emphasizes performing a full-range activity when that type of movement facilitates mobility. A 2013 review primarily included small case series and reported potential benefits of physical therapy, though the evidence remains limited.¹³

A walking aid or the use of the other arm can help ensure safety and independence. The physical therapist reassesses these adaptations to allow, whenever possible, for increased use of the affected limb. Some people still need assistance despite rehabilitation.⁶ Needs also vary depending on symptoms: a study of 160 people found greater physical difficulties in the group with primarily walking difficulties than in certain other groups.¹⁴

What are the fundamental principles of FND physiotherapy?

Physical therapy for TNF is based on four principles: understanding the diagnosis, trying ways to divert attention, practicing more automatic movements, and gradually resuming difficult activities.⁶

Focusing attention on the task at hand can make certain movements easier. For example, a person may walk more easily by following a rhythm than by watching every step. Gait rehabilitation programs combine several strategies; their results do not measure the long-term effect of rhythm or distraction alone.^{15, 6}

In some people, a functional symptom varies depending on whether they are focused or distracted. This response is one clinical indicator among others.

The physical therapist may ask you to count, tell a story, or follow a target during an activity. They observe your movement and ensure your safety before choosing a strategy to repeat.¹¹

A more automatic movement requires less conscious monitoring. For example, reaching out to grab an object may be easier than controlling each part of the arm separately. Regions of the brain, including the motor cortex, which is involved in controlling movement, contribute to both conscious and more automatic movements. The 2013 study shows that these two ways of performing a task can be affected differently.¹⁰ Another experiment, involving fourteen people with TNF and fourteen without, observed a difference in the perception of the force applied by their own hand.¹⁶ These observations help in studying the sense of control over movement. They do not prove that all voluntary control is impaired, nor that all automatic movements are preserved.¹⁰

Positive signs are observations that support the diagnosis, such as strength that varies depending on the task.² The clinician interprets these findings in conjunction with the overall examination. A study on functional weakness also shows that the difficulties experienced can be just as significant as those experienced by people with weakness related to another neurological disorder.¹⁷

Gradual exposure involves gradually resuming an activity that you find frightening or that you avoid. For example, a physical therapist might start with a few steps in a safe environment before working on a longer walk. Not everyone experiences fear, and fear alone does not explain TNF.^{18, 6}

Understanding the diagnosis helps connect the observed signs to the recommended strategies. The physical therapist explains that the symptoms are real and that change is possible. The therapist may also discuss hypervigilance—an intense, anxious focus on sensations or movements. However, understanding the disorder does not guarantee that the symptoms will disappear.⁹

How does physiotherapy treatment for FND work?

Physical therapy for TNF involves explaining the diagnosis, finding ways to make difficult movements easier, and having the patient practice activities in stages. The physical therapist may modify an instruction, the pace, or the setting, and then observe whether the movement becomes easier.⁶

The brain combines signals from the body with what it expects to perceive. Some models suggest that an imbalance between these pieces of information contributes to functional symptoms. These models remain hypotheses; they do not allow us to read a person’s thoughts or, on their own, determine the cause of their TNF.⁸

Functional magnetic resonance imaging produces images of changes in brain activity. A study involving sixteen people with functional motor symptoms and sixteen people without TNF examined their responses to faces expressing emotions. It observed differences in response in a region associated with emotions and in its interactions with a region involved in preparing movement.¹⁹ Another study, focusing on tremor, also observed differences in emotion-related networks.²⁰ These observations do not prove that stress causes all functional neurological disorders or that a distraction technique leads to a cure.

What is motor distraction and how does it help FND?

Motor distraction involves directing one’s attention toward a conversation, a rhythm, or some other action during a difficult movement. It can make a task easier for some people. Programs that use this technique also combine information with gradual practice; their benefits do not prove the isolated effect of distraction.^{15, 6}

At the CHUM, Pierre-Luc Lévesque describes games and dual tasks, such as walking while holding an object. The team then returns to a more typical walking pattern once the task is going more smoothly.¹¹

Distraction techniques include several strategies:

Cognitive dual-task training involves combining a movement with a mental activity, such as counting or conversing while walking. The physical therapist selects a task that sufficiently diverts attention without compromising balance.⁶

A dual motor task combines two actions, such as walking while carrying a light object. The physical therapist first checks whether this combination makes walking easier and remains safe.⁶

Rhythmic movements follow music, a counting pattern, or a metronome—a device that produces regular beats. Rhythm can serve as a guide for walking or arm movements.⁶ Functional walking disorders take many forms; one study describes, in particular, a slow gait or knees that bend suddenly.²¹ The choice of rhythm therefore depends on the movement being observed.

Visual cues provide a goal for the movement: reaching a target with the hand or walking toward a specific point. The physical therapist may also use lines on the floor to guide the steps.⁶

Humor and conversation can divert attention away from symptoms during an activity. Their use should be appropriate for the person and respectful of what they are going through.¹¹

A task performed at the same time can occupy the hand or the attention during a difficult movement. This strategy is consistent with models that study the role of attention in movement control, without confirming a single mechanism.²² The physical therapist tests its effectiveness in real-world situations before adopting it.⁶

What is retraining automatic movements?

Retraining automatic movements involves performing complete activities, such as walking, reaching for an object, or standing up from a chair. The goal is to make the movement easier without having to consciously control each muscle separately.⁶ In a trial involving sixty people with a functional walking disorder, a three-week hospital-based program improved walking and daily living abilities compared to a waiting period. The observed improvements were maintained at the one-year follow-up.¹⁵

The physical therapist assesses strength, endurance, balance, and coordination—that is, how movements are linked together. He then ties the exercises to a specific goal, such as walking to a store or standing up without assistance. Pierre-Luc Lévesque describes this combination of assessment and tasks in the podcast.¹¹

For some people with TNF, paying very close attention to each step of a movement can disrupt it. The assessment then compares different instructions, such as watching one’s steps or walking toward a target. The observed change guides practice; it does not, on its own, predict recovery.^{10, 6}

To practice leg lifts, the physical therapist may suggest taking a short walk with support, stepping over a low obstacle with assistance, or putting on pants while seated. Each activity provides a purpose for the movement. The height and level of assistance are adjusted to minimize the risk of falling.⁶

In this context, a functional activity is a useful action in daily life. The term “functional” in the diagnosis also describes a functional impairment, without implying that the symptoms are fabricated or that they necessarily have a psychological cause.¹²

Gradual exposure can be used in conjunction with this practice when an activity is frightening. A first step might be a short movement with support. The physical therapist can then increase the distance, range of motion, or speed as the patient becomes able to do so.^{18, 6}

What specific techniques are used in FND physiotherapy?

The recommended techniques may include visual targets, dual-task training, rhythmic exercises, and gradual exposure. Motor imagery and mirror therapy may also be considered in certain cases. The level of evidence varies among these techniques; no single method is suitable for all symptoms.⁶

Graded motor imagery first involves identifying the right or left side in images, then imagining a movement, and finally using a mirror. In a trial involving 51 people with phantom pain following amputation or complex regional pain syndrome, this step-by-step approach improved pain and functional ability compared to standard physical therapy and medical care. The benefits persisted at six months.²³ Phantom pain is felt in an amputated limb. Complex regional pain syndrome may involve persistent pain in a limb along with changes in sensation, color, temperature, or swelling. This trial did not focus on TNF.

Another study evaluated a one-week intensive program for functional motor disorders, rather than motor imagery alone. It compared sixty treated participants with sixty participants in a control group selected from previous records. At long-term follow-up, 60.4% of the treatment group reported significant improvement or a return to near-normal function, compared with 21.9% of the control group.²⁴ The groups were not randomly assigned, which limits the certainty regarding the proportion of improvement attributable to the treatment.

Visually guided movements use a target, lines on the floor, a mirror, or a video. For example, watching the hand reach for an object can provide a different reference point than the sensation of controlling each part of the arm. The physical therapist observes whether this reference point is helpful or whether it requires too much attention to the movement.⁶

Walking training can help you practice shifting your weight from one leg to the other, adjusting your stride length, changing your pace, or stepping over a small obstacle.⁶ Functional walking impairments can vary from person to person and depending on the task.²¹ Support and assistance are selected based on the risk of falling.

Dancing movements can provide a rhythmic and enjoyable activity when balance allows.⁶ The walking trial evaluated a comprehensive rehabilitation program, with benefits for walking and daily activities. It did not measure the effect of dance used on its own.¹⁵

Gradual exposure targets a feared activity, such as walking outside or using a limb to perform a task. It begins with a tolerable step and then progresses along with the person. Fear and emotions can contribute to difficulties, but they are not necessary for a TNF.^{18, 6}

Mirror therapy uses the reflection of a limb to create the impression that the hidden limb is moving. Early research on this technique focused in particular on phantom pain following amputation.²⁵ Its specific effect on functional motor symptoms remains uncertain. One report describes a significant improvement in a tremor following eight weeks of rehabilitation combining mirror therapy with neuropsychological treatment, which addresses the connections between brain function and behavior.²⁶ This case does not allow the result to be attributed to the mirror alone. A pilot study involving fourteen adults instead combined virtual reality—computer-generated images—with a mirror and exposure approach. This report presented the study as still ongoing, with no results available to clearly compare the effectiveness of the two programs.²⁷

Who can benefit from physiotherapy for FND?

People with functional weakness, tremors, or gait disorders may benefit from physical therapy. Treatment may also address functional dystonia, which involves sustained involuntary postures or movements. Changes in symptoms in response to attention may guide the exercises, but stress or immediate improvement through distraction are not prerequisites for receiving care.

A shorter duration of symptoms was associated with a better prognosis in some studies included in a 2014 review.²⁸ A 2025 meta-analysis, which combined the quantitative results of several studies, also observed slightly smaller improvements in motor and physical function when symptoms had persisted for a longer period.²⁹ Nevertheless, individuals with long-standing symptoms showed improvement on several measures. These associations do not prove that earlier treatment alone leads to better recovery. In the 2014 review, the favorable association with a shorter duration was reported in only two studies, and most of the studies were retrospective, meaning they were based on data that had already been collected.²⁸

Physical therapy primarily addresses motor symptoms—those that affect movement. Sensory disturbances and functional episodes require a separate evaluation. Multiple treatments may be combined when warranted by coexisting symptoms or conditions.¹

Which types of symptoms respond best to FND physiotherapy?

Studies do not allow for a reliable classification of weakness, tremor, and gait disturbances based on their response to physical therapy. Physio4FMD has studied several motor symptoms and concludes that there is still a need to better identify the individuals who benefit most from the program.³ The previous feasibility study was also not designed to establish this classification.⁴

The 2017 feasibility study yielded encouraging initial results after six months.⁴ Physio4FMD then compared a specialized nine-session program with follow-up care to a referral to standard neurological physical therapy. At twelve months, there was no clear difference in self-reported physical functioning between the groups. However, perceived motor improvement and certain mental health outcomes favored the specialized program.³

Functional weakness can severely limit activities, even though strength may vary depending on the task.¹⁷ The physical therapist may use weight shifting, standing up, or an arm exercise to find a movement that is easier to perform. A change observed during the exercise does not guarantee that it will occur in all activities.⁶

For functional tremors, a different task can modify the movement and guide the exercise. One study compared thirteen people with functional tremors to twenty-five people with tremors of a different origin. The study involved, among other things, tapping out a rhythm and performing a rapid movement with the other arm.³⁰ Certain responses distinguished between the groups, but no single test was reliable enough to determine the diagnosis. A reduction in tremor during distraction alone does not predict that the reduction will persist over time.³⁰

Gait disorders can be addressed by modifying foot placement, rhythm, or the task being performed. The CHUM offers TNF rehabilitation, which includes a physical therapy evaluation and mobility goals tailored to individual needs.⁵ The speed of change varies from person to person.

Functional dystonia can be addressed by trying different positions, engaging in meaningful activities, and gradually resuming movement. A study on fixed abnormal postures reports some improvements following multidisciplinary rehabilitation.³¹ Not all participants in this study had a definitive functional diagnosis. Therefore, the study does not allow for a comparison of the response to functional dystonia with that to weakness or tremor.

Sensory disturbances, such as functional numbness, require an evaluation of sensory perception and other possible causes. Pain may also accompany TNF without necessarily being a functional sensory symptom.¹Chronic pain—pain that has persisted or recurred for more than three months—may require specific treatment goals and additional care.

Dissociative seizures, also known as non-epileptic functional seizures, are involuntary episodes that may resemble an epileptic seizure, which is associated with abnormal electrical activity in the brain. Cognitive-behavioral therapy (CBT), a form of psychotherapy that addresses thoughts, emotions, and behaviors, may be recommended. In the CODES trial involving 368 adults, adding this therapy to medical care did not show a clear reduction in seizure frequency at 12 months compared with medical care alone.³² However, several secondary outcomes favored CBT, including daily activities, seizure-related distress, and the longest seizure-free period. These results were assessed among numerous measures and should be interpreted with greater caution than the primary outcome. Physical therapy may complement care if motor symptoms or activity difficulties are also present.^{32, 1}

When should I consult a physiotherapist for FND?

You can begin physical therapy after receiving medical confirmation of TNF to assess which movements and activities you can resume. If you have unexplained neurological symptoms, a medical evaluation is still necessary; physical therapy should not delay it. Some studies link a shorter duration to a better outcome, though they do not prove that starting treatment earlier causes this difference.²⁸ The absence of a comprehensive program does not prevent you from discussing a tailored treatment plan. This decision is guided by your needs, the therapist’s expertise, and safety considerations.⁶

In Quebec, you can see a physical therapist directly at a private clinic without a doctor’s prescription. However, some insurance plans or public healthcare facilities require a referral. Check the requirements that apply to your situation.³³ This direct access does not replace medical confirmation of a TNF and does not guarantee an appointment within a specific timeframe.

Symptoms that have been present for a long time do not rule out a benefit. In the functional walking trial, the three-week program improved activities and walking, with gains maintained at one year.¹⁵ The duration of symptoms is therefore not sufficient grounds to deny treatment or to predict how long your recovery will take.

While waiting at the CHUM, you can discuss with the team the possibility of tailored follow-up care outside the program. The clinic requires a medical referral and confirms the diagnosis during its evaluation. Rehabilitation then begins a few weeks or months later, depending on the situation.⁵ If you’re seeing a physical therapist elsewhere, be sure to tell them about any evaluations and advice you’ve already received.

If the diagnosis is not confirmed, a normal physical examination or improvement with distraction alone is not sufficient to conclude that TNF is present. The physician—often a neurologist—interprets the positive signs in conjunction with the symptoms, the physical examination, and other possible causes.^{2, 1}

Call 911 if you experience sudden weakness in your face or on one side of your body, or sudden difficulty speaking. These signs may indicate a stroke, even if they go away. Do not attribute a new symptom to TNF without evaluation. The signs of a stroke described by the NHS, the United Kingdom’s public health service, also include certain sudden changes in vision or balance, or a very severe headache.

Also call emergency services if you witness an initial seizure that resembles an epileptic seizure, a seizure that lasts longer than usual, or one that lasts more than five minutes if the usual duration is unknown. A failure to regain full consciousness, multiple seizures without recovery, a serious injury, or difficulty breathing after a seizure also require urgent medical attention. For seizures that have already been evaluated, follow the plan established with the medical team. The NHS guidelines for seizures provide further details on these situations.

What can I expect during physical therapy treatment for TNF?

Physical therapy treatment for TNF begins with an assessment of your symptoms, range of motion, and the activities you’d like to resume. The physical therapist then explains the recommended strategies and works with you to develop a program. Progress may be gradual and vary from person to person; follow-up visits are also used to adjust the treatment plan when difficulties persist.⁶

The first meeting also gives you a chance to ask questions: How was the diagnosis made? What is the purpose of an exercise? And when should the plan be reviewed? A clear explanation helps you understand the connection between the assessment and the recommended care, though it does not guarantee a specific outcome.⁹

What happens during the first FND physiotherapy assessment?

The initial assessment reviews the history of symptoms, examines movement and positive signs, and then identifies the activities that are important to you. It helps determine which movement exercises to try first and identifies any medical or other care needs.⁶

The history of your symptoms includes when they began, how they have progressed, and the situations that make them worse or better. The physical therapist may ask, “Do your symptoms change from one day to the next? What happens when you focus your attention on something else?” These answers are part of the evaluation; they do not, by themselves, lead to a diagnosis.³⁴

The physical examination looks for signs that are useful for diagnosis and for selecting appropriate tasks. For weakness in one leg, the clinician may use Hoover’s sign. For a tremor, the clinician may compare the rhythm of the tremor with that tapped out by the other hand. The clinician may also observe the patient’s gait in various settings.²

The Hoover sign compares the force of a leg push against the bed in two situations. This push may be weak when requested directly, but then become stronger when the person lifts the other thigh against resistance. The second movement normally results in an automatic push with the opposite leg.¹ The clinician interprets this contrast in the context of the entire examination. Its absence alone does not rule out a TNF.²

The physical therapist can measure strength using a dynamometer, a device that measures pushing or pulling force. The therapist also observes differences between tasks, variations depending on attention, and movements that become easier. These observations support the assessment when interpreted in conjunction with the patient’s history, physical examination, and other possible causes.^{17, 1}

The diagnosis of TNF is based on positive clinical signs. It is not based solely on the absence of another explanation, and treatment can help patients resume their activities.

The activity assessment specifies what you can do: walk a certain distance, climb a flight of stairs, get dressed, or work. These benchmarks allow us to compare your progress over the course of our appointments.³⁵

Information about the condition explains the reality of the symptoms and the signs observed. The physical therapist can present models that illustrate the role of the brain’s expectations, distinguishing them from established facts. Understanding the diagnosis does not guarantee that the symptoms will disappear.⁹

The physical therapist may observe whether a movement changes in response to a different instruction or a distraction during the evaluation. Such a change may support the diagnosis and indicate that the individual possesses the ability to perform that task. However, it does not, on its own, predict the long-term effect of treatment.³⁶

At the end of the evaluation, the physical therapist will work with you to develop a treatment plan. The plan will specify the activities to focus on, the strategies to try, the planned frequency of sessions, and the criteria for reviewing the plan. Your goals, preferences, and any challenges you face in accessing care will be part of this discussion.⁶

How long does treatment last and how often are sessions needed?

The duration and frequency vary depending on the program and individual needs. For example, Physio4FMD offered nine sessions and a follow-up visit, while the CHUM program generally lasts eight to twelve weeks.^{3, 5} These formats do not represent an optimal treatment regimen for everyone. Further research is needed to determine the optimal amount of treatment and the most appropriate combinations.¹

The CHUM program brings together professionals from various fields for eight to twelve weeks.⁵ In the 2023 podcast, Delphine Bélanger explains that the physical therapy assessment takes place before occupational therapy. Pierre-Luc Lévesque then describes six physical therapy sessions—including one assessment—spread over three weeks. This example of how the program was organized at that time does not require an identical sequence in all programs.¹¹

The first meetings are used to test strategies and set clear goals.¹ People interviewed before their physical therapy sessions described their need for explanations and the impact of the condition on their lives.³⁷ Follow-up care should address these concerns, in addition to movement practice.

The agreed-upon frequency should also take access to care into account. At a private clinic, ask about fees and check your insurance coverage before your appointments. The professional must inform you of the cost of care.³³

Sessions include active practice tailored to your current abilities. Fatigue, pain, safety concerns, and activities between sessions can affect your rate of progress, in addition to the severity of your symptoms.⁶

The program may begin with an explanation of the disorder and a trial of strategies. The exercises then gradually move toward the desired activities. More infrequent sessions can help assess independence and prepare for the end of follow-up care.⁶ Progression remains variable, as shown by long-term follow-up studies.²⁸

Living with persistent symptoms can be difficult. Some patients describe feeling misunderstood or helpless before receiving care.³⁷ You can voice your concerns and request a reassessment of the program when it no longer meets your needs. A slow recovery does not mean you are not trying hard enough.

What results can I expect and within what timeframe?

Results may include easier walking, improved use of the limb, or the resumption of an activity. In the 2017 feasibility study, 72% of the treatment group reported an improvement at six months, compared with 18% of the group receiving usual care.⁴ This encouraging result does not predict your recovery time.

The study randomly assigned sixty people to the two groups. Three withdrew before the analysis, which included 57 people. Random assignment aims to create comparable groups, but the small size of a feasibility study limits the accuracy of its results.⁴

This study also found that the specialized group reported better physical abilities at the six-month mark.⁴ In the larger Physio4FMD trial, however, this result was not clearly distinguishable between the groups at 12 months. Certain other benefits, including perceived motor improvement, favored the specialized program.³

In Quebec, the CHUM program offers TNF rehabilitation that generally lasts eight to twelve weeks.⁵ This timeframe describes the structure of the program. It does not set a specific recovery date for each individual.

The time it takes to see improvement varies. Follow-up studies have reported a wide range of outcomes, with no single factor that can predict an individual’s specific outcome.²⁸ In the gait rehabilitation trial, improvements were observed after three weeks and were sustained at the one-year follow-up.¹⁵ These measurement points describe this program without setting a specific timeframe for all TNF patients.

The duration and severity of symptoms, understanding of the diagnosis, opportunities for exercise, and other health issues guide the discussion. They do not allow for a reliable estimate of the rate of recovery.²⁸ A 2025 review found no consistent link to age or symptom duration, while another observed slightly smaller physical gains with longer duration.^{38, 29} These differing results highlight the limitations of individual predictions. The program remains based on your current needs.²⁸

Improvement may involve periods of stability or temporary flare-ups of symptoms. A plan developed with healthcare professionals helps you know what activities to resume and when to consult them.⁶ A study of 127 people also evaluated a self-care guide combined with brief follow-up sessions: improvements in overall health were more common at three months than with standard care alone. This difference was no longer evident at six months, although some measures of symptoms and activity levels remained better.³⁹

Significant improvement depends on your goals. For example, this could mean walking without assistance, reducing a tremor by half, or resuming a hobby. These examples are not guaranteed outcomes. Being able to do an activity again can be significant even if symptoms persist. Your goals should also take into account what affects you the most in your daily life.³⁷

How does FND physiotherapy integrate with other treatments?

Physical therapy for TNF can be combined with occupational therapy, psychotherapy, and medical follow-up, depending on your symptoms and goals. The occupational therapist focuses on daily and work-related activities. The psychologist may address anxiety, mood issues, or the impact of the disorder. The neurologist confirms the diagnosis and evaluates other possible conditions. Pain management or assistance with returning to work may also be helpful.⁵

For functional motor symptoms, the recommendations prioritize physical therapy and occupational therapy. Evidence also supports psychotherapy for certain forms of TNF.⁴⁰ The role of each profession depends on the specific challenges being addressed; psychotherapy may become the primary intervention for some individuals.

TNF may involve brain function, life experiences, and social context, to varying degrees depending on the individual.⁴¹ A synthesis of seventeen systematic reviews reports potential benefits of tailored care that combines multiple interventions. However, it rates the quality of the evidence as moderate at best.⁴² It therefore does not demonstrate that any single combination is superior for every individual.

What is the role of occupational therapy in FND treatment?

Occupational therapy helps patients resume personal care, household chores, school, or work. A consensus recommends explaining the condition, practicing real-life activities, and developing strategies that can be used in daily life.³⁵ These recommendations suggest an approach to treatment; they do not measure the isolated effect of each intervention.³⁵

In the 2023 podcast, Delphine Bélanger, an occupational therapist and psychologist with the CHUM program, describes how occupational therapy follows the initial physical therapy sessions. She then helps the patient apply these strategies to activities that are important to them.¹¹

The occupational therapy assessment examines your daily activities: personal care (washing, dressing, eating), household activities (cooking, cleaning, shopping), leisure and social activities, and work or school. Which activities have you stopped doing because of your symptoms? Which ones do you still do, but with great difficulty? What are your priorities for recovery?³⁵

The occupational therapist applies rehabilitation principles to your daily activities. For example, you can practice reaching for a cup in the cupboard or doing some grocery shopping. A meaningful task can make a movement easier by focusing your attention on the goal. The effect varies, and the activity must remain safe.³⁵

Adapting the environment can support safety and independence when challenges persist. An occupational therapist can assess the need for an assistive device or a change in the living space and teach you how to use it. The consensus recommends reevaluating these adaptations and promoting the resumption of movement whenever possible, while continuing to use necessary assistive devices after incomplete rehabilitation.³⁵

Preparing to return to work may involve a reduced schedule, breaks, and modified tasks. The occupational therapist helps plan the progression and discuss helpful accommodations. Some people may need a different role if they cannot return to their previous position despite these changes.³⁵ The plan also takes into account the concerns and impacts experienced.³⁵

Energy management involves balancing activities and rest periods. Fatigue can accompany TNF and limit one’s ability to perform daily activities. An occupational therapist can help identify priority tasks, break them down into smaller steps, and avoid alternating between overly busy days and periods of complete inactivity.^{35, 6}

Why is psychotherapy recommended even if my TNF isn't "all in my head"?

Psychotherapy can help address anxiety, mood issues, fear, or the impact of symptoms on daily life. The approach is chosen in consultation with the individual and does not imply that the disorder is imaginary.³² In the CODES study, CBT added to medical care improved certain measures of functioning and distress in adults with dissociative episodes, with no clear difference in episode frequency at 12 months.³² These results do not automatically apply to all forms of TNF.

The symptoms of TNF are real and involuntary. No psychological factors are required to make the diagnosis. Research is exploring various connections between the brain, sensations, movement, and life experiences.⁴³ A psychological factor may be relevant for an individual without explaining all cases of TNF.¹

Psychological counseling can also help you cope with the uncertainty and the effects of the disorder. The goals should be tailored to your specific challenges, rather than based on the assumption that all TNF stems from stress.¹⁸

CBT for dissociative episodes can address several difficulties that accompany the symptoms.

CBT can address highly distressing interpretations of symptoms. For example, the fear that a certain action will cause harm to the body may lead a person to avoid it. The therapist helps the person assess this fear and gradually resume the activity when it is safe to do so.^{39, 32}

Therapy may also address the focus on sensations. The individual then tries strategies to engage in an activity without constantly monitoring every sensation. These strategies are discussed when this difficulty arises.²²

Anxiety and depression may occur alongside TNF and require their own treatment. Their presence does not prove that they caused the motor symptoms.⁴⁴ A review reports that 40 to 100 percent of people experience mental health disorders, depending on the form of TNF and the assessment method, with anxiety and mood disorders being the most common.⁴⁵ This very wide range does not yield a proportion applicable to all individuals. These difficulties may have preceded the symptoms or developed during the course of the disease.

If stress plays a role in your situation, counseling can help you develop stress management strategies, such as recognizing difficult situations and preparing ways to cope with them. Their effect on functional symptoms may vary.¹⁸

Psychotherapy focused on psychological trauma may be considered when a highly distressing experience continues to affect the individual.⁴⁶ A meta-analysis found a higher prevalence of difficult life events among individuals with TNF than in control groups. However, every study that sought to identify individuals without such events ultimately found some: therefore, a traumatic event is not required for diagnosis.⁴⁷

A small study examined prolonged exposure—a therapy that gradually addresses avoided memories and situations—in individuals with both non-epileptic seizures and post-traumatic stress disorder, which can cause intrusive memories and avoidance of situations that remind them of the traumatic event. Of the eighteen participants enrolled, sixteen completed twelve to fifteen sessions. Thirteen of them reported no more episodes by the last session, and the other three reported fewer episodes. Depressive and post-traumatic symptoms had also improved.⁴⁶ The absence of a control group makes it impossible to isolate the effect of the treatment. This study does not allow these benefits to be attributed to other trauma therapies.

Physical therapy and psychotherapy are combined when they address different needs. Motor skills care relies primarily on physical therapy and occupational therapy.⁴⁰ In CODES, CBT was provided in addition to medical care, with no mandatory physical therapy included in the protocol.³² At the CHUM, the various professions coordinate treatment goals based on individual needs. Concurrent psychological follow-up is not a requirement for everyone.^{41, 5}

Antidepressants can treat depression or certain anxiety disorders that occur at the same time. Evidence of the drugs’ effect on TNF itself remains limited.⁴² No medication has clearly established efficacy for treating all forms of TNF. The choice of medication must therefore be based on a specific indication discussed with the prescribing healthcare professional.

What can I do at home to complement FND physiotherapy?

At home, you can practice the recommended exercises, work toward a specific goal, and gradually resume your daily activities or hobbies. Your physical therapist will work with you to choose activities and guidelines that are appropriate for your abilities and ensure your safety.⁶

Practicing between sessions helps you apply strategies in your daily life. It can help you get back into the swing of things, but it doesn't guarantee steady progress. Recovery depends on several factors and isn't based solely on your efforts.⁶ Patients interviewed before treatment described, among other things, frustration and a sense of helplessness.³⁷

What exercises can I do alone at home?

You can repeat a specific task you’ve already tried with your physical therapist, such as walking to another room at a steady pace or reaching for a light object. Start in the agreed-upon setting and use the necessary support. Some tasks must first be practiced with assistance.⁶

The duration and frequency of your home practice depend on the activity and how well you recover between sessions. If you experience increased fatigue or pain, discuss the amount of practice with your instructor before trying to do more.⁶

The following principles can serve as a guide for the treatment plan agreed upon with your physical therapist.

You can redirect your attention to another task. Counting, talking, or focusing on a target can make it easier to move. Stick with the strategy that helps you perform the activity without compromising your safety.¹⁵

You can practice during a real-life activity. For example, reach for a cup on a low shelf or walk over to get the mail. These tasks give your movements a purpose. Choose an object, a distance, and a support that have already been determined with your physical therapist.⁶

You can gradually vary the settings. After completing a task in a familiar room, you can try another room or a short walk outside, if your abilities allow it. The physical therapist will help you choose the next setting.⁶

You can track the activities you’re able to do. For example, note the distance you’ve traveled or a task you’ve resumed. Monitoring your symptoms can also be helpful; if this becomes very worrisome or overwhelming, talk to someone about it so you can adjust how you track your progress.⁶

The following activities are examples that should be adapted in consultation with a physical therapist.

Walking can be done to music or by counting when this provides a helpful cue. Choose a familiar route and appropriate support, then agree on the duration with the physical therapist.⁶

Free dance involves performing rhythmic movements in an open space. It is appropriate only if the movements and balance required allow for this activity to be performed safely.⁶ The walking study involved a comprehensive program and does not demonstrate a specific effect of dance.¹⁵

Household chores, such as sweeping, cooking, or gardening, give purpose to your movements. Break tasks down according to your abilities. Music can be helpful for certain activities, but avoid distractions when a task requires your full attention to ensure safety.⁶

Rhythmic movements can follow a song, such as tapping one's foot or swinging one's arms. The physical therapist checks to see if the rhythm makes the movement easier.⁶ The physical therapy consensus recommends this type of cue for certain symptoms, though it does not guarantee that it will be effective for everyone.⁶

A favorite pastime can be resumed in small steps. Choose a part of the activity that is still possible and enjoyable, then discuss how to move forward. The goal of resuming the activity may be to participate before symptoms disappear completely.³⁵

What mistakes should I avoid during my recovery?

During recovery, avoid sticking to a strategy that constantly complicates movement or judging all progress based on a single fluctuation. A new, different, or concerning symptom requires reevaluation; a TNF may coexist with another problem.¹

The following examples are meant to help identify a practical difficulty. They do not imply that your symptoms are caused by a mistake or a lack of effort.³⁷

Pushing harder doesn’t always help the movement. Focusing too intensely can sometimes make the movement less fluid. If this happens, go back to the instructions or guidelines agreed upon with your physical therapist rather than constantly increasing your effort.¹⁰

Monitoring every sensation can become overwhelming. Useful observations also focus on the activities you’ve done. If you remain very anxious despite the explanations, ask to review how to track your symptoms and progress. Perception models examine this role of attention, though they do not explain every case.²²

Fear can limit your return to an activity. If you’re feeling afraid, a physical therapist can help you start off on a safe footing. The goal is to resume the activity, not to force you to ignore a new symptom.¹⁸

Comparing recovery times does not predict your own recovery. If someone else reports feeling better after six weeks, that does not set a timeline for you. Symptoms, treatments, and circumstances vary. You can discuss your expectations and any ongoing difficulties.^{37, 28}

A recurrence of symptoms calls for an adjustment to the plan, not an automatic conclusion that the treatment has failed. Fluctuations may occur during recovery, but not every worsening of symptoms is necessarily normal. Resume the agreed-upon strategies and contact the team if symptoms persist, change, or cause you concern. An emergency situation must be evaluated immediately.^{6, 28}

Reevaluate as needed. A diagnosis of TNF can guide treatment without precluding further evaluation. If a new, different, or concerning symptom appears, consult a healthcare professional; TNF may coexist with another condition.¹ This approach acknowledges the reality of symptoms and avoids reducing all difficulties to a single functional diagnosis.⁴⁸

Why choose Physioactif for your FND treatment?

Physioactif offers an assessment of your movements and activities, followed by a personalized plan or a referral for the necessary care. At our clinics in the Greater Montreal area, you can schedule a physical therapy appointment directly. Please mention your TNF diagnosis and your specific needs when scheduling your appointment so we can verify the services and expertise available.⁴⁹

You can ask for explanations about the proposed strategies and the professional’s experience with TNF. A respectful approach to treatment acknowledges the reality of your symptoms and takes your priorities into account.¹

Understanding TNF helps professionals explain the signs and select appropriate tasks. The 2015 consensus report specifically describes distraction and the practice of automatic movements.⁶ Standard neurological physical therapy can also be helpful. Physio4FMD found no clear superiority of the specialized program in terms of physical abilities at 12 months, though it did observe certain other favorable outcomes.³ The choice depends on your needs and the care available to you.⁶

Direct access to a private clinic allows you to schedule a physical therapy appointment without a prescription. However, some insurance plans may require a referral in order to cover the cost of treatment.³³ This access does not replace medical confirmation of the TNF.

Waiting times depend on the department and availability. At the CHUM, rehabilitation begins a few weeks or a few months after the medical evaluation, depending on the situation.⁵ At Physioactif, ask about actual availability. A consultation should not delay a necessary medical evaluation.

The personalized plan takes into account your symptoms, your other health issues, and the activities that matter to you. Your progress is reassessed with you; it should not impose a fixed recovery date on you.^{37, 6}

With your consent, we can collaborate with your other healthcare providers to share goals and relevant information. This coordination is intended to ensure consistency in care, but does not guarantee a specific clinical outcome.⁴¹

Our clinics in the Greater Montreal area offer several locations for appointments. The choice of location and frequency depends on your needs, availability, and the agreed-upon plan.⁴⁹

The telerehabilitation service allows for certain remote sessions when the assessment and planned activities can be conducted safely. The program continues to be based on the activities to be resumed and strategies tailored to the individual.⁶ A pilot study followed eighteen individuals with functional motor impairments for 24 weeks. It combined three in-person sessions with twenty-one remote sessions. At twelve and then twenty-four weeks, 66.7% and 77.8% of participants, respectively, reported an improvement. Motor function measures and certain aspects of quality of life also improved.⁵⁰ Since the study did not include a control group, it does not demonstrate the specific effect of remote sessions. However, it does show that a combined program was studied in individuals with TNF.

Please schedule an appointment if you would like to discuss your functional motor symptoms and a rehabilitation plan tailored to your situation.

References

Links open in a new tab.

1. Espay AJ, Aybek S, Carson A, Edwards MJ, Goldstein LH, Hallett M, et al. Current Concepts in the Diagnosis and Treatment of Functional Neurological Disorders. JAMA Neurol. 2018;75(9):1132-1141. (Back to sections: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15)
2. Daum C, Hubschmid M, Aybek S. The value of “positive” clinical signs for weakness, sensory, and gait disorders in conversion disorder: a systematic and narrative review. J Neurol Neurosurg Psychiatry. 2014;85(2):180-90. (Back to sections: 1, 2, 3, 4, 5)
3. Nielsen G, Stone J, Lee TC, Goldstein LH, Marston L, Hunter RM, et al. Specialist physiotherapy for functional motor disorder in England and Scotland (Physio4FMD): a pragmatic, multicenter, phase 3 randomized controlled trial. Lancet Neurol. 2024;23(7):675-686. (Back to sections: 1, 2, 3, 4, 5, 6)
4. Nielsen G, Buszewicz M, Stevenson F, Hunter R, Holt K, Dudziec M, et al. Randomized feasibility study of physical therapy for patients with functional motor symptoms. J Neurol Neurosurg Psychiatry. 2017;88(6):484-490. (Back to sections: 1, 2, 3, 4, 5, 6, 7)
5. Services Offered at the TNF Clinic. (Back to sections: 1, 2, 3, 4, 5, 6, 7, 8, 9)
6. Nielsen G, Stone J, Matthews A, Brown M, Sparkes C, Farmer R, et al. Physiotherapy for functional motor disorders: a consensus recommendation. J Neurol Neurosurg Psychiatry. 2015;86(10):1113-9. (Back to sections: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48)
7. Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. Lancet. 2011;377(9778):1693-702. (Back to section: 1)
8. Edwards MJ, Adams RA, Brown H, Pareés I, Friston KJ. A Bayesian account of “hysteria.” Brain. 2012;135(Pt 11):3495-512. (Back to passages: 1, 2)
9. Explanation as a Treatment for Functional Neurological Disorders. Handbook of Clinical Neurology. 2016:543-553. (Back to sections: 1, 2, 3, 4)
10. Pareés I, Kassavetis P, Saifee TA, Sadnicka A, Davare M, Bhatia KP, et al. Failure of explicit movement control in patients with functional motor symptoms. Mov Disord. 2013;28(4):517-23. (Back to sections: 1, 2, 3, 4, 5, 6)
11. 59- Functional Neurological Disorders with Pierre-Luc Lévesque and Delphine Bélanger | Talk to Me About Health. (Back to sections: 1, 2, 3, 4, 5, 6, 7)
12. Edwards MJ, Stone J, Lang AE. From psychogenic movement disorder to functional movement disorder: it's time to change the name. Mov Disord. 2014;29(7):849-52. (Back to sections: 1, 2)
13. Nielsen G, Stone J, Edwards MJ. Physiotherapy for functional (psychogenic) motor symptoms: a systematic review. J Psychosom Res. 2013;75(2):93-102. (Back to section: 1)
14. Gelauff JM, Rosmalen JGM, Gardien J, Stone J, Tijssen MAJ. Shared demographics and comorbidities in different functional motor disorders. Parkinsonism Relat Disord. 2020;70:1-6. (Back to section: 1)
15. Jordbru A, Smedstad L, Klungsøyr O, Martinsen E. Psychogenic gait disorder: A randomized controlled trial of physical rehabilitation with a one-year follow-up. Journal of Rehabilitation Medicine. 2014;46(2):181-187. (Back to sections: 1, 2, 3, 4, 5, 6, 7, 8)
16. Pareés I, Brown H, Nuruki A, Adams RA, Davare M, Bhatia KP, et al. Loss of sensory attenuation in patients with functional (psychogenic) movement disorders. Brain. 2014;137(Pt 11):2916-21. (Back to section: 1)
17. Stone J, Warlow C, Sharpe M. The symptom of functional weakness: a controlled study of 107 patients. Brain. 2010;133(5):1537-1551. (Back to sections: 1, 2, 3)
18. Pick S, Goldstein LH, Perez DL, Nicholson TR. Emotional processing in functional neurological disorders: a review, biopsychosocial model, and research agenda. Journal of Neurology, Neurosurgery & Psychiatry. 2018;90(6):704-711. (Back to sections: 1, 2, 3, 4, 5, 6)
19. Voon V, Brezing C, Gallea C, Ameli R, Roelofs K, LaFrance WC, et al. Emotional stimuli and motor conversion disorder. Brain. 2010;133(Pt 5):1526-36. (Back to section: 1)
20. Espay AJ, Maloney T, Vannest J, Norris MM, Eliassen JC, Neefus E, et al. Impaired emotion processing in functional (psychogenic) tremor: A functional magnetic resonance imaging study. Neuroimage Clin. 2018;17:179-187. (Back to section: 1)
21. Baik JS, Lang AE. Gait abnormalities in psychogenic movement disorders. Mov Disord. 2007;22(3):395-9. (Back to sections: 1, 2)
22. Van den Bergh O, Witthöft M, Petersen S, Brown RJ. Symptoms and the Body: Taking the Inferential Leap. Neuroscience & Biobehavioral Reviews. 2017;74:185-203. (Back to sections: 1, 2, 3)
23. Moseley GL. Graded motor imagery for pathological pain: a randomized controlled trial. Neurology. 2006;67(12):2129-34. (Back to section: 1)
24. Czarnecki K, Thompson JM, Seime R, Geda YE, Duffy JR, Ahlskog JE. Functional movement disorders: Successful treatment with a physical therapy rehabilitation protocol. Parkinsonism & Related Disorders. 2012;18(3):247-251. (Back to section: 1)
25. Ramachandran VS, Rogers-Ramachandran D. Synesthesia in phantom limbs induced by mirrors. Proc Biol Sci. 1996;263(1369):377-86. (Back to section: 1)
26. Joos A, Halmer R. Chronic Functional Tremor: Positive Findings in Management, Including Mirror Therapy. Case Rep Neurol. 2020;12(2):175-179. (Back to section: 1)
27. Bullock K, Won AS, Bailenson J, Friedman R. Virtual Reality-Delivered Mirror Visual Feedback and Exposure Therapy for FND: A Midpoint Report of a Randomized Controlled Feasibility Study. J Neuropsychiatry Clin Neurosci. 2020;32(1):90-94. (Back to section: 1)
28. Gelauff J, Stone J, Edwards M, Carson A. The prognosis of functional (psychogenic) motor symptoms: a systematic review. J Neurol Neurosurg Psychiatry. 2014;85(2):220-6. (Back to sections: 1, 2, 3, 4, 5, 6, 7, 8, 9)
29. Thomas ST, Thomas ET, Schembri E, Lehn AC, Palmer DD. Treatment outcomes in functional neurological disorders: a systematic review and meta-analysis exploring the influence of symptom chronicity. BMJ Neurol Open. 2025;7(2):e001150. (Back to sections: 1, 2)
30. Schwingenschuh P, Katschnig P, Seiler S, Saifee TA, Aguirregomozcorta M, Cordivari C, et al. Moving toward "laboratory-supported" criteria for psychogenic tremor. Mov Disord. 2011;26(14):2509-15. (Back to sections: 1, 2)
31. Schrag A, Trimble M, Quinn N, Bhatia K. The syndrome of fixed dystonia: an evaluation of 103 patients. Brain. 2004;127(Pt 10):2360-72. (Back to section: 1)
32. Goldstein LH, Robinson EJ, Mellers JDC, Stone J, Carson A, Reuber M, et al. Cognitive behavioral therapy for adults with dissociative seizures (CODES): a pragmatic, multicenter, randomized controlled trial. Lancet Psychiatry. 2020;7(6):491-505. (Back to sections: 1, 2, 3, 4, 5, 6)
33. OPPQ. How does it work? (Back to sections: 1, 2, 3)
34. Stone J, Carson A, Sharpe M. Functional symptoms and signs in neurology: assessment and diagnosis. J Neurol Neurosurg Psychiatry. 2005;76 Suppl 1(Suppl 1):i2-12. (Back to section: 1)
35. Nicholson C, Edwards MJ, Carson AJ, Gardiner P, Golder D, Hayward K, et al. Occupational therapy consensus recommendations for functional neurological disorders. J Neurol Neurosurg Psychiatry. 2020;91(10):1037-1045. (Back to sections: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10)
36. Stone J, Edwards M. Trick or treat? Neurology. 2012;79(3):282-284. (Back to section: 1)
37. Nielsen G, Buszewicz M, Edwards MJ, Stevenson F. A qualitative study of the experiences and perceptions of patients with functional motor disorders. Disabil Rehabil. 2020;42(14):2043-2048. (Back to sections: 1, 2, 3, 4, 5, 6, 7)
38. Sekine ER, Kanaan RA, McMillan J, Oxford S, Iles RA. Biopsychosocial prognostic indicators in functional neurological disorders: A systematic review. J Psychosom Res. 2025;195:112201. (Back to section: 1)
39. Sharpe M, Walker J, Williams C, Stone J, Cavanagh J, Murray G, et al. Guided self-help for functional (psychogenic) symptoms. Neurology. 2011;77(6):564-572. (Back to sections: 1, 2)
40. Aybek S, Perez DL. Diagnosis and management of functional neurological disorders. BMJ. 2022;376:o64. (Back to sections: 1, 2)
41. O'Neal MA, Baslet G. Treatment for Patients With a Functional Neurological Disorder (Conversion Disorder): An Integrated Approach. Am J Psychiatry. 2018;175(4):307-314. (Back to sections: 1, 2, 3)
42. Mavroudis I, Petrides F, Franekova K, Ionescu C, Ciobica A, Kazis D. Treatment of functional neurological disorders: an umbrella review of systematic reviews and meta-analyses. J Neurol. 2025;272(11):710. (Back to sections: 1, 2)
43. Hallett M, Aybek S, Dworetzky BA, McWhirter L, Staab JP, Stone J. Functional neurological disorder: new subtypes and shared mechanisms. Lancet Neurol. 2022;21(6):537-550. (Back to section: 1)
44. Kranick S, Ekanayake V, Martinez V, Ameli R, Hallett M, Voon V. Psychopathology and psychogenic movement disorders. Mov Disord. 2011;26(10):1844-50. (Back to section: 1)
45. Carle-Toulemonde G, Goutte J, Do-Quang-Cantagrel N, Mouchabac S, Joly C, Garcin B. Overall comorbidities in functional neurological disorders: A narrative review. Encephale. 2023;49(4S):S24-S32. (Back to section: 1)
46. Myers L, Vaidya-Mathur U, Lancman M. Prolonged exposure therapy for the treatment of patients diagnosed with psychogenic non-epileptic seizures (PNES) and post-traumatic stress disorder (PTSD). Epilepsy & Behavior. 2017;66:86-92. (Back to sections: 1, 2)
47. Ludwig L, Pasman JA, Nicholson T, Aybek S, David AS, Tuck S, et al. Stressful life events and maltreatment in conversion (functional neurological) disorder: systematic review and meta-analysis of case-control studies. Lancet Psychiatry. 2018;5(4):307-320. (Back to section: 1)
48. Rommelfanger KS, Factor SA, LaRoche S, Rosen P, Young R, Rapaport MH. Disentangling Stigma from Functional Neurological Disorders: Conference Report and Roadmap for the Future. Front Neurol. 2017;8:106. (Back to section: 1)
49. Contact Us: Greater Montreal Physical Therapy - Physioactif. (Back to sections: 1, 2)
50. Demartini B, Bombieri F, Goeta D, Gambini O, Ricciardi L, Tinazzi M. A physical therapy program for functional motor symptoms: A telemedicine pilot study. Parkinsonism Relat Disord. 2020;76:108-111. (Back to section: 1)